Long-term outcome of cervical and thoracolumbar dural arteriovenous fistulas with emphasis on sensory disturbance and neuropathic pain

Mizuya Shinoyama, Toshiki Endo, Toshiyuki Takahash, Hiroaki Shimizu, Akira Takahashi, Michiyasu Suzuki, Teiji Tominaga

Research output: Contribution to journalReview articlepeer-review

23 Citations (Scopus)

Abstract

Background: Clinical features and prognosis of sensory disturbance in spinal dural arteriovenous fistula (SDAVF) have not been well documented. Here we report long-term outcomes and detailed sensory evaluations of surgically treated SDAVF, including 14 patients with the craniocervical fistulas. Methods: Thirty-four consecutive patients with SDAVF treated at our institute during a period of 14 years were reviewed (mean age, 64.6 years; 67.6% men). Fistulas were located at the craniocervical junction in 14 patients (CC group) and in the thoracolumbar spine in 20 patients (TL group). In the CC group, six patients presented with subarachnoid hemorrhage. Fistulas were found incidentally in seven patients. One patient in the CC group and all patients in the TL group presented with progressive myelopathy. Most patients underwent microsurgery either alone (30 patients) or combined with embolization (3 patients). One patient was treated by embolization only. The follow-up ranged from 12 to 145 months (mean, 57 months). Results: All but one patient in the CC group had excellent surgical outcome. Most patients in the TL group stabilized or improved neurologically. Shorter duration before treatment indicated better gait recovery. Important, a few patients in the TL group suffered worsening or development of new pain, as well as lesser degree of improvement in gait and micturition. Spinal cord atrophy was correlated with clinical deterioration. Conclusions: In craniocervical SDAVF, surgical treatment provides favorable long-term outcomes without risk of recurrence. In the thoracolumbar SDAVF, irreversible structural changes, such as spinal cord atrophy, may lead to poor recovery. Early diagnosis and treatment are thus warranted.

Original languageEnglish
Pages (from-to)401-408
Number of pages8
JournalWorld Neurosurgery
Volume73
Issue number4
DOIs
Publication statusPublished - 2010 Apr

Keywords

  • Craniocervical
  • Myelopathy
  • Neuropathic pain
  • Spinal cord atrophy
  • Spinal dural arteriovenous fistula
  • Subarachnoid hemorrhage
  • Venous congestion

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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